Sustaining progress in the health landscape of Bangladesh
Authors: Dipak Kumar Mitra, Malay Kanti Mridha
Journal: The Lancet Global Health (2023)

In November, 2013, the Lancet Series on Bangladesh highlighted the country as an exceptional and exemplary health performer in the south Asia region. This success was achieved despite Bangladesh having a weak health system, low health-care expenditure, and widespread poverty. Several political, social, and economic factors were identified as contributing to this success, including the national renaissance followed by the Bangladesh Liberation War in 1971, high-quality research into strengthening the health system, international cooperation,1Das P Horton R Bangladesh: innovating for health.Lancet. 2013; 382: 1681-1682Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar the reduction of gender inequality and the empowerment of women, a pluralistic health system, the innovative use of community-based approaches for health care, and an enhanced ability to fight natural disasters.2Sen A What's happening in Bangladesh?.Lancet. 2013; 382: 1966-1968Summary Full Text Full Text PDF PubMed Google Scholar 10 years after the publication of this Series, Sheikh Mohammed Shariful Islam and colleagues3GBD 2019 Bangladesh Burden of Disease CollaboratorsThe burden of diseases and risk factors in Bangladesh, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Glob Health. 2023; 11: e1931-e1942Google Scholar report more success stories for health in Bangladesh, along with some future challenges, in The Lancet Global Health. Systematic analyses of data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) reveal that, between 1990 and 2019, life expectancy at birth in Bangladesh increased by 28·2%, all-cause disability-adjusted life-years decreased by 54·9%, and the age-standardised mortality rate declined by 52·7%. Despite a reduction in deaths from communicable diseases, with a high proportion of deaths now attributed to non-communicable diseases, Bangladesh now faces a double burden of both disease categories,4Biswas T Haider MM Das Gupta R Uddin J Assessing the readiness of health facilities for diabetes and cardiovascular services in Bangladesh: a cross-sectional survey.BMJ Open. 2018; 8e022817 Crossref Scopus (28) Google Scholar and health-system and multisectoral interventions to prevent and control such diseases are needed.5WHOBangladesh adopts multisectoral action plan for noncommunicable disease control and prevention.https://www.who.int/bangladesh/news/detail/050–22–019-bangladesh-adopts-multisectoral-action-plan-for-noncommunicable-disease-control-and-preventionDate: Feb 5, 2019Date accessed: September 30, 2023Google Scholar More specifically, among the top 20 causes of death in 2019, 14 were non-communicable diseases and two were communicable diseases, in addition to neonatal disorders, congenital defects, road injuries, and drowning. Between 1990 and 2019, the highest decline in age-standardised mortality rates was observed for diarrhoeal diseases (from 166·1 to 31·2 deaths per 100 000 population; an 81·2% reduction), followed by tuberculosis (135·2 to 22·6 deaths per 100 000 population; an 83·3% reduction). However, in the case of non-communicable diseases, a substantial reduction in the age-standardised mortality rate was achieved only for chronic obstructive pulmonary diseases (54·6% reduction) and asthma (72·9% reduction), with only modest declines for stroke (22·8% reduction), ischaemic heart disease (2·7% reduction), chronic kidney disease (20·2% reduction), and some cancers; an increase was reported for diabetes (5·8% increase), breast cancer (4·2% increase), and Alzheimer's disease (7·2% increase). In 2019, among the south Asian countries for which GBD data are available (Bhutan, India, Bangladesh, Nepal, and Pakistan), Bangladesh was the top performer in terms of reducing mortality, years of life lost, and years lived with disability, and improving life expectancy at birth and healthy life expectancy. Despite the decline in mortality from key non-communicable diseases, behavioural and metabolic risk factors for such diseases are increasing. In 1990, only two metabolic risk factors featured in the list of top ten risk factors associated with age-standardised all-cause deaths, whereas in 2019, all five metabolic risk factors were among the top ten. Moreover, both ambient and household air pollution are also included in the 2019 top ten. Further investigation is needed to explain the decline in mortality and morbidity from non-communicable diseases despite the proportionate increase in their immediate risk factors. The plateauing of the decreasing trend of years lived with disability and mortality after 2010 also needs further explanation and investigation. Future challenges for Bangladesh include the provision of universal health care and the reduction of out-of-pocket expenses for health care,6Fahim SM Bhuayan TA Hassan MZ et al.Financing health care in Bangladesh: policy responses and challenges towards achieving universal health coverage.Int J Health Plann Manage. 2019; 34: e11-e20Crossref PubMed Scopus (0) Google Scholar a shortage of trained health-care workers, the presence of under-regulated informal and profit-based private health-care systems,7Kabir A Karim MN Billah B Health system challenges and opportunities in organizing non-communicable diseases services delivery at primary healthcare level in Bangladesh: a qualitative study.Front Public Health. 2022; 101015245 Crossref Scopus (2) Google Scholar and a lack of emphasis on the primary and secondary prevention of non-communicable diseases. The double burden of communicable and non-communicable diseases and related challenges in Bangladesh have been acknowledged in the Sustainable Development Report 2023.8Sachs JD Lafortune G Fuller G Drumm E Sustainable development report 2023: implementing the SDG stimulus.https://www.sdgindex.org/reports/sustainable-development-report-2023/Date: June 21, 2023Date accessed: September 23, 2023Google Scholar This report suggests that Bangladesh has made only moderate progress towards the targets of Sustainable Development Goal 3, regarding good health and wellbeing, and will face major challenges to reach these targets. Bangladesh cannot therefore be complacent with its health achievements, despite being the top performer in the south Asia region in terms of several key indicators of health. The findings from this Article will be crucial and timely to guide the policy makers and programme managers of Bangladesh to establish health priorities, as the country is currently developing its fifth 5-year plan for the health, population, and nutrition sector. We declare no competing interests. The burden of diseases and risk factors in Bangladesh, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019Over the past 30 years, mortality rates have reduced by more than half in Bangladesh. Bangladesh must now address the double burden of communicable and non-communicable diseases. Cost-effective, multisectoral efforts are needed to prevent and control non-communicable diseases, promote healthy lifestyles, and prevent premature mortality and disabilities. Full-Text PDF Open Access